Ask the Experts: Medicaid Billing
How should I bill New York Medicaid for services provided by non-hospital employee clinicians in emergency department settings?
Fishing Lessons
Providers may object when value-based savings accrue to health plans. Although those objections have merit, other factors should be considered when formulating strategy.
declining self pay admissions could improve U S hospital revenue streams
A review of the data for the period of 2012-14 points to a continuing decline in self pay admissions under the implementation of the Affordable Care Act (ACA), with the percentage of total admissions processed as self pay dropping to
APCs: An Important Primary Care Resource for Value-Based Care
Health systems should look to advanced practice clinicians, including nurse practitioners and physician assistants, as qualified providers who can fill the gaps in primary care resulting from a declining supply of primary care physicians.
Putting Your Financial Team to Work to Maximize MACRA Benefits
Joncé Smith describes how finance leaders can help ready their organizations for MACRA.
FY18 Proposed Changes to the Long-Term Care Hospital (LTCH) Prospective Payment System
This document summarizes the FY18 payment rate updates under the long-term care hospital prospective payment system (LTCH PPS), published by CMS in the April 28, 2017, Federal Register.
Q&A: Exploring the Nuances of MACRA
Physician practices and other healthcare organizations should be aware of various nuances that will affect their performance in both the MIPS and advanced APM tracks of MACRA.
Gauging the Financial Impact of MIPS
The financial impacts of MIPS scores can amount to millions of dollars per organization and will significantly grow over the next several years.
Why Horizon BCBSNJ Likes Episode-of-Care Payments
Horizon Blue Cross Blue Shield of New Jersey’s episode-of-care program, believed to be the largest such program in the country, rewards physicians for successes but does not subject them to penalties. Horizon says that this arrangement creates better foundations for payer/provider relationships to move toward shared risk over time.
Toward a Common Vision for Value Based Care Metrics
Reporting dozens of potentially conflicting metrics from government and commercial payers can be a burden on providers, who seek ways to streamline or prioritize the number of metrics.